Wesley Wilson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

9117569 Issued in FL

Practice address

4930 E Lake Mary Blvd
Sanford, FL 32771-5003

Phone

(407) 322-8645

Fax

(407) 269-8986

NPI assigned

Aug 23, 2023

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Premier Community Healthcare Group Inc

  • Federally Qualified Health Center (FQHC)
  • Dade City, FL
  • NPI 1841263399
  Medicare reassignment NPD
• Premier Community Healthcare Group, Inc.

  • Federally Qualified Health Center (FQHC)
  • Zephyrhills, FL
  • NPI 1508445362
  NPD
• Central Florida Family Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Orlando, FL
  • NPI 1649241704
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1692748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748476800000",
    "number": "1760266373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4930 E LAKE MARY BLVD",
            "city": "SANFORD",
            "state": "FL",
            "postal_code": "327715003",
            "telephone_number": "407-322-8645",
            "fax_number": "833-314-0572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4930 E LAKE MARY BLVD",
            "city": "SANFORD",
            "state": "FL",
            "postal_code": "327715003",
            "telephone_number": "407-322-8645",
            "fax_number": "407-269-8986"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "652 Wren Dr",
            "address_purpose": "LOCATION",
            "city": "Casselberry",
            "state": "FL",
            "postal_code": "327074817",
            "country_code": "US",
            "telephone_number": "407-417-0201",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "37920 Medical Arts Ct",
            "address_purpose": "LOCATION",
            "city": "Zephyrhills",
            "state": "FL",
            "postal_code": "335414323",
            "country_code": "US",
            "telephone_number": "352-518-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "WESLEY",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-08-23",
        "last_updated": "2025-05-29",
        "certification_date": "2025-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "9117569",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shane Nicholas Williamson, LMHC
• Cynthia Willingham
• Jessica Willis, CRNA
• Rebecca Willoughby
• Aundraya Wilson, PTA
• Sheena Wimberly, LPN
• Wing Surgical PA
• Brian Wisherd, MA, CCC-SLP
• James E Witherspoon IV, CCEMT-P, CCHW
• Austin B Witnauer, DPT

• Physician Assistant in Sanford, FL
• Providers in Sanford, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.